WHO ‘not fit for purpose’ on Ebola

The Ebola crisis has shown that the World Health Organisation (WHO) is “not a fit for purpose health emergency agency”, the author of a damning report has said.

The independent review, commissioned by WHO in March, found the epidemic “exposed organisational failings” and highlighted the need for it to make “fundamental changes”.

Ebola broke out in Guinea in December 2013 but was not declared a public health emergency by WHO until August last year – which has been partly blamed for the rapid spread to neighbouring Sierra Leone and Liberia, resulting in more than 11,000 deaths.

WHO, which is part of the United Nations, has a number of responsibilities including identifying any emergencies or hazards that pose a threat to human health and co-ordinating the response.

According to the report, WHO “does not currently possess the capacity or organisational culture to deliver a full emergency public health response”.

It found the WHO tended to adopt a reactive rather than a proactive approach to emergencies and report panel chairwoman Dame Barbara Stocking – a former chief executive of Oxfam GB – said that instead of just monitoring what is going on, a ” change in culture to a much more proactive way of working” is needed.

She described the report as a “defining moment for global health security”.

“At this moment it is not a fit for purpose health emergency agency,” she told reporters.

“Was WHO late in calling that emergency? The answer is yes.”

But she said there were a number of reasons for this, such as there being little access to data in the affected countries, their governments being unwilling to declare the problem, and “nervousness” from WHO after it was severely criticised for calling a public health emergency for swine flu.

She said it would have been better if there had been an intermediate stage where the scale of the problem was properly assessed before being declared an emergency.

The report recommends the creation of a single, unified WHO Centre for Health Emergency Preparedness and Response, to be based on the currently separate outbreak and humanitarian areas of work.

Funding for emergency response was also found to be “lacking”, and the panel recommended that further investments be made with “vigour”.

Other criticisms include that WHO does not have a ” culture that supports open and critical dialogue between senior leaders and staff or that permits risk-taking or critical approaches to decision-making”.

“There seems to have been a hope that the crisis could be managed by good diplomacy rather than by scaling up emergency action,” it added.

Other agencies also come in for criticism, with the report finding that “the engagement of the wider humanitarian system came very late in the response”, and the panel was ” surprised” that many donors, governments, the UN and international non-governmental organisations understood only either the health emergency or the humanitarian system.

The panel said that in Sierra Leone, the involvement of British armed forces meant command and control was not initially given to civilian leadership, and while there may be a place for military support “as agreed in civil/military guidelines, this must be under civilian control”.

It also pointed out that there are clear disincentives for countries to report outbreaks quickly and transparently, as they are often penalised by other countries as a result.

It described the epidemic as “largest and most complex Ebola outbreak on record”, with 27,443 reported, confirmed, probable or suspected cases as of June 28.

“The outbreak also put enormous strain on national and international response capacities, including WHO’s outbreak and emergency response structures.

“The panel remains extremely concerned about the grave health, social and economic costs of the Ebola outbreak.

“In light of the unpredictable nature of outbreaks and other health crises – and the mounting scale of ecological changes that may trigger them – improving WHO’s leadership and response to events such as these is critical.

“The panel firmly believes that this is a defining moment not only for WHO and the global health emergency response, but also for the governance of the entire global health system.

“The world simply cannot afford another period of inaction until the next health crisis.”

A WHO spokesman said it welcomed the report.

“WHO is already moving forward on some of the panel’s recommendations including the development of the global health emergency workforce and the contingency fund to ensure the necessary resources are available to mount an initial response,” he added.